Cyclothymia · What Is It, How It Is Managed, and More

Cyclothymia, also known as cyclothymic disorder, is a chronic mood disorder that commonly presents in adolescence with large swings in mood and energy. People with cyclothymia typically experience fluctuating periods of persistently elevated mood, or hypomanic symptoms, and low mood, or depressive symptoms. Changes in mood can occur quickly and at any given time.  

People with cyclothymia may easily be differentiated from those with bipolar I disorder, which is characterized by cycles of manic and depressive episodes. A person who experiences hypomanic symptoms, like with cyclothymia, rather than manic episodes has fewer, less intense, or shorter symptoms than those that occur during a manic episode. Cyclothymia is similar to bipolar II disorder, which is also characterized by hypomania, but with cyclothymia the individual’s symptoms don’t meet the criteria for a full hypomanic or major depressive episode. 

The exact cause of cyclothymia is currently unknown. Cyclothymia is likely multifactorial, including genetics, psychological factors, and environmental factors. Understanding these factors may help optimize the prevention and treatment of cyclothymia.  

Genetics may play a role, as individuals with a family history of cyclothymia, depression, or bipolar disorder are more likely to be diagnosed with cyclothymia. Some psychological features, such as a personal history of a depressive disorder, can also serve as risk factors. Changes in brain chemistry and biology due to injuries, aging, or stress, as well as environmental and social factors, such as prolonged periods of stress or traumatic life experiences, may contribute to the development of cyclothymia.  

Symptoms of cyclothymia may include mood swings fluctuating between emotional highs (i.e., hypomania) and emotional lows (i.e., depression).  

Hypomanic symptoms are characterized by an unusually elevated or irritable mood, alongside an atypical increase in energy, for a short period of time (less than 4 days). Additional symptoms may include a high level of self-esteem, excessive talking, racing thoughts, an unusually strong focus on tasks and goals, physical energy and alertness despite minimal sleep, increased agitation, and involvement in risky activities.  

Depressive symptoms are characterized by an abnormally low mood for a short period of time (less than 2 weeks), a decreased interest in activities the individual previously enjoyed, or both. Additional symptoms may include low self-esteem, loss of appetite, difficulty falling asleep or staying awake, fatigue, either jittery or significantly slow physical activity (i.e., psychomotor agitation or retardation), decreased ability to concentrate, and recurrent thoughts of self-harm. 

People with cyclothymic disorder may experience sudden mood swings at any given time, which may negatively impact their ability to function day-to-day. 

Differential diagnoses involve considering various possible conditions that could be causing symptoms and then ruling out each one through use of history, clinical evaluation, diagnostic tests, and critical thinking. This process helps to narrow down the list of potential diagnoses to determine the most likely cause of the symptoms.  

Differential diagnoses can be broken down into four categories: most likely, less likely, least likely, and can’t miss. Most likely diagnoses are conditions most probable based on symptoms and clinical presentation. Less likely diagnoses are not as probable but should still be considered. On the other hand, least likely diagnoses can be considered if other, more probable conditions are excluded. Finally, can’t miss diagnoses are less common but critical to promptly identify and treat as they can lead to severe consequences.  

Diagnosis is based on history and physical examination. Since the exact cause of cyclothymia is unknown, diagnosis and treatment includes ruling out other conditions with similar symptoms based on the criteria defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).  

A formal diagnosis of cyclothymia may only be made in individuals who have experienced distressing or impairing symptoms over a period of at least 2 years, at least 50% of the time, without being symptom-free for more than 2 months within those 2 years. In contrast, symptoms must be present for at least 1 year in children and adolescents in order to meet diagnostic criteria. For individuals of any age, the symptoms must never last long enough or be severe enough at any time to meet criteria for a hypomanic, manic, or major depressive episode.  

For example, a hypomanic episode consists of at least 3 mood or behavioral symptoms experienced for 4 days to 1 week to the degree that they impact the individual’s functioning, but they are not severe enough to cause impairment or warrant hospitalization. A manic episode also consists of 3 or more symptoms, but the symptoms last for at least a week, they are severe enough to impair the individual, they may require hospitalization, and psychotic symptoms may be present. Depressive symptoms are considered a major depressive episode if at least 5 symptoms present together for at least a 2-week period. When the number, severity, and duration of the individual’s symptoms add up to any of the 3 types of episodes, a clinician should determine whether the individual’s symptoms fit a diagnosis of bipolar II disorder, bipolar I disorder, major depressive disorder, or a different disorder, rather than cyclothymia. 

In addition, physical examination and laboratory tests, such as blood or urine samples, may be required to rule out the influence of other medical conditions, such as Cushing disease. Diagnosis must also exclude the possibility that the symptoms are a side effect of medication or substance use.  

Since the symptoms of cyclothymia are less severe or pervasive than those experienced during a hypomanic or manic episode, individuals may not initially seek treatment. In individuals who seek treatment, symptoms of hypomania may not be recognized at first, resulting in treatment of other conditions instead, such as unipolar depression. If left untreated, cyclothymia can increase the risk of developing bipolar disorder.  

The treatment of cyclothymia usually depends on the severity of the condition, the medical history of the individual, and their preferences. Treatment is focused on mood stabilization and helping individuals cope with their condition, which may involve lifestyle approaches, psychotherapy, and medications.  

Lifestyle approaches that may be recommended include relaxation techniques, such as meditation or deep breathing, avoidance of specific cyclothymia triggers (e.g., stressful situations or negative social interactions), and joining a cyclothymia support group.  

Psychotherapy treatment options commonly include cognitive behavioral therapy (CBT) under the supervision of a qualified mental health professional. CBT focuses on exploring and adapting the individual’s mental, emotional, and behavioral response to situations that could trigger or contribute to mood swings, in order to reduce the negative impacts of their symptoms.   

There are no medications specifically approved for the treatment of cyclothymia. However, some healthcare professionals may prescribe mood stabilizers, such as lithium, to optimize symptom management. Antidepressants (e.g., sertraline), antipsychotics (e.g., quetiapine) and antianxiety medications (e.g., clonazepam), may also be prescribed separately or in combination with other medications to better manage symptoms of cyclothymia.